Principals, Approaches and Tools for Stigma-Reduction in Health Facilities Laura Nyblade, PhD Senior Technical Advisor

1. Principals, Approaches and Tools for Stigma-Reduction in Health FacilitiesLaura Nyblade, PhDSenior Technical Advisor, Stigma & DiscriminationHealth Policy Project and RTI

2. Background Why Definitions & Conceptualization Forms & consequences Overview of general stigma-reduction program strategies Examples of how they have been applied in health care settings Tools & Resources Presentation �Guide�

3. ��. If we do not appreciate the natureand impact of stigma, none of our interventions can begin to be successful.�� Edward Cameron, Constitutional Court Justice in South Africa

4. Powerful social process that: Turns �difference� into inequity & disadvantage Maintains/upholds inequitable structures Leads to social & economic exclusion Fuels and can be used to justify violations of human rights, discriminatory policies & laws Intensifies & sustains vulnerability Impedes access to health & other services Why? Prevention Testing Disclosure Safe Sex (e.g. condom negotiation) PMTCT 26% to 53% of vertical transmissions due to stigma Risk Recognition Treatment Access Uptake & Adherence Delivery/Quality of Care Human capacity/staff Prevention Testing Disclosure Safe Sex (e.g. condom negotiation) PMTCT 26% to 53% of vertical transmissions due to stigma Risk Recognition Treatment Access Uptake & Adherence Delivery/Quality of Care Human capacity/staff

5. Stigma impedes programmatic efforts  Prevention Testing Disclosure Risk Recognition Treatment Treatment Access Timely uptake Adherence Delivery/Quality of Care Human Capital Health care providers receiving care Secondary S&D

6. Forms-Impact on People�s Lives Physical and social isolation Loss of relationships Gossip & Verbal Abuse Loss of livelihood Loss of housing Rejection by peers Loss of reputation Violence Denial or sub-standard health care Internalized stigma

7. Forms-Health ProvidersStigma Indicators Working Group, Tanzania, 2005 Neglect Had to wait longer Not having bed pans changed Receiving less care/attention Denied care Denied treatment Referral to another provider/facility Senior provider pushed client to a junior provider Junior provider pushed client to a senior provider Differential treatment HIV test required before care was given HIV test required before scheduling surgery Using gloves for non-invasive exams Extra precautions in sterilizing instruments Lack of consent HIV testing without consent Disclosing HIV status to family without client�s consent